*The U.S. Equal Employment Opportunity Commission*

----

# QUESTIONS AND ANSWERS:ENFORCEMENT GUIDANCE ON DISABILITY-RELATED INQUIRIES ANDMEDICAL EXAMINATIONS OF EMPLOYEES UNDER THE AMERICANS WITHDISABILITIES ACT (ADA)

## INTRODUCTION

***What does this Guidance address?*****

- The  Guidance  explains the ADA's rules concerning when employers may and may notobtain medical information about their employees.

***Why did the EEOC issue this Guidance?*****

- In October 1995, the EEOC issued enforcement guidance explaining the ADA's rulesconcerning when an employer may and may not make disability-related inquiries andrequire medical examinations of  applicants .  Since that time, we have had manyinquiries from EEOC investigators and attorneys in the field, employers, andemployees about how the law applies with respect to  people who are alreadyworking .  This Guidance is intended to answer some of the most frequently-askedquestions we have received.

***To whom does the Guidance apply?*****

- The Guidance applies to private and to state and local government employers withfifteen or more employees.  Federal sector employers are also covered by theGuidance, as the result of the 1992 amendments to the Rehabilitation Act.
- The ADA's requirements regarding disability-related inquiries and medicalexaminations apply to  all  of the employees of a covered employer, whether or not theyhave disabilities.

## IN GENERAL

***Are the rules about when an employer may make disability-related inquiries and requiremedical examinations the same for employees and applicants?  (Introduction)***  (For moreinformation about this and other issues discussed in these Questions and Answers, pleaseconsult the referenced question numbers from the Guidance.)

- No.  The ADA limits an employer's ability to make disability-related inquiries orrequire medical examinations at three stages:  pre-offer ,  post-offer , and  duringemployment . The rules concerning disability-related inquiries and medicalexaminations are different at each stage.   - 	At the first stage  (prior to an offer of employment) , an employer may not askany disability-related questions or require any medical examinations, even ifthey are related to the job.
  - 	At the second stage  (after an applicant is given a conditional job offer, butbefore he or she starts work),  an employer may ask disability-relatedquestions and conduct medical examinations, regardless of whether they arerelated to the job, as long as it does so for all entering employees in the samejob category.
  - 	At the third stage  (after employment begins),  an employer may makedisability-related inquiries and require medical examinations only if they are job-related and consistent with business necessity. 

***What is a "disability-related inquiry"? (Question 1)***

- A "disability-related inquiry" is a question that is likely to elicit information about adisability, such as asking employees about:  whether they have or ever had adisability; the kinds of prescription medications they are taking; and, the results of anygenetic tests they have had.
- Disability-related inquires also include asking an employee's co-worker, familymember, or doctor about the employee's disability.   Questions that are*not* likely to elicit information about a disability are alwayspermitted, and they include asking employees about their general well-being; whetherthey can perform job functions; and about their current illegal use of drugs.   ***What is a "medical examination"?  (Question 2)***    - A "medical examination" is a procedure or test usually given by a health careprofessional or in a medical setting that seeks information about an individual'sphysical or mental impairments or health.  Medical examinations include vision tests;blood, urine, and breath analyses; blood pressure screening and cholesterol testing; anddiagnostic procedures, such as x-rays, CAT scans, and MRIs.  ***Are there any procedures or tests employers may require that would not be consideredmedical examinations?  (Question 2)***    - Yes.  There are a number of procedures and tests that employers may require that arenot considered medical examinations, including:  blood and urine tests to determinethe current illegal use of drugs; physical agility and physical fitness tests; andpolygraph examinations.  JOB RELATED AND CONSISTENT WITH BUSINESS NECESSITY  ***When may an employer ask an employee a disability-related question or require anemployee to submit to a medical examination?  (Question 5)***    - Generally, an employer only may seek information about an employee's medicalcondition when it is  job related and consistent with business necessity .  This meansthat the employer must have a reasonable belief based on objective evidence that:      - 	an employee will be unable to perform the essential functions his or her jobbecause of a medical condition; or,
    - 	the employee will pose a direct threat because of a medical condition. 
  - Employers also may obtain medical information about an employee when theemployee has requested a  reasonable accommodation  and his or her disability orneed for accommodation is not obvious.
  - In addition, employers can obtain medical information about employees when they:       - 	are required to do so by another  federal law or regulation  (e.g., DOT medicalcertification requirements for interstate truck drivers);  *(Question 21)*
    - 	offer  voluntary  programs aimed at identifying and treating common healthproblems, such as high blood pressure and cholesterol;  *(Question 22)*
    - 	are undertaking  affirmative action  because of a federal, state, or local law thatrequires affirmative action for individuals with disabilities or voluntarily usingthe information they obtain to benefit individuals with disabilities.   *(Question23)*  ***What should an employer do if it learns about an employee's medical condition fromsomeone else? (Question 6)***    - First, the employer should determine whether the information learned is  reliable .  Theemployer should consider how well the person providing the information knows theindividual, the seriousness of the medical condition, and how the person learned theinformation.
  - The employer should then determine whether the information gives rise to areasonable belief that the employee in question will be unable to perform the essentialfunctions of his or her job because of the medical condition or will pose a direct threatbecause of the condition. 
  - If the information does give rise to such a reasonable belief, then the employer maymake disability-related inquiries or require a medical examination as permitted by theGuidance.  ***May an employer ask all employees what prescription medications they are taking?(Question 8)***    - Generally, no.  In limited circumstances, however, employers may be able to ask employees in positions affecting public safety  about their use of medications thatmay affect their ability to perform essential functions and  thereby result in a directthreat .
  - For example, an airline could require pilots to report when they are taking medicationsthat may affect their ability to fly.  A fire department, however, could not requireemployees in administrative positions  to report their use of medication because it isunlikely that these employees would pose a direct threat as a result of an inability, orimpaired ability,  to do their jobs.  ***What may an employer do if it believes that an employee is having performance problemsbecause of a medical condition, but the employee won't answer any questions or go to thedoctor?  (Question 9)***    - The employer may discipline the employee for his or her performance problems just asit would any other employee having similar performance problems.  SCOPE AND MANNER OF INQUIRIES AND EXAMINATIONS  ***May an employer have an employee who is requesting a reasonable accommodationexamined by its own health care provider? (Question 11)***    - In some instances, yes.  If the employer has explained what type of documentation isneeded, and the employee fails to provide it or provides insufficient documentation,the employer may require the employee to see a health care professional of theemployer's choice.
  - Even where an employee initially provides insufficient documentation, however, theemployer should consider asking the employee's health care provider for additionalinformation before requiring an examination by the employer's health careprofessional.  This is because an employee's health care provider frequently is in thebest position to provide information about the employee's limitations.  ***May an employer have an employee who it reasonably believes will pose a direct threatexamined by its own health care provider?  (Question 12)***    - Yes.  This is because the employer is responsible for assessing whether an employeeposes a direct threat based on a reasonable medical judgment that relies on the  mostcurrent medical knowledge and/or best objective evidence .
  - The health care professional the employer chooses should have expertise in theemployee's specific medical condition and be able to provide medical information thatallows the employer to determine the effects of the condition on the employee's abilityto perform his or her job.
  - If the employer's health care professional believes that the employee poses a directthreat, but the employee's own doctor disagrees, the employer should evaluate theconflicting medical information by considering, for example, the area of expertise ofeach medical professional; the kind of information each provided; and, whether theinformation provided is consistent with the employer's own observations of orknowledge about the employee.  DISABILITY-RELATED INQUIRIES AND MEDICAL EXAMINATIONS RELATEDTO LEAVE  ***May an employer request that an employee provide a doctor's note or other explanationwhen the employee has used sick leave?  (Question 15)***    - Yes.  An employer is entitled to know why an employee is requesting sick leave.  Anemployer, therefore, may ask an employee to provide a doctor's note or otherexplanation, as long as it has a policy or practice of requiring all employees to do so.  ***May an employer ask disability-related questions or require a medical examination when anemployee who has been on leave for a medical condition wants to return to work? (Question 17)***    - Yes, if an employer has a reasonable belief that an employee's  present  ability toperform essential functions will be impaired by a medical condition or that he or shewill pose a direct threat because of a medical condition.
  - Any inquiries or examination, however, must be limited in scope to what is needed todetermine whether the employee is able to work.  PERIODIC MEDICAL EXAMINATIONS AND TESTING  ***May employers require employees to have periodic medical examinations?  (Question 18)***    - No, with  very limited exceptions  for employees who work in positions affectingpublic safety, such as police officers, firefighters, or airline pilots.  Even in theselimited situations, the examinations must address specific job-related concerns.  Forexample, a police department could periodically conduct vision tests orelectrocardiograms because of concerns about conditions that could affect the ability toperform essential job functions and thereby result in a direct threat.  A policedepartment could not, however, periodically test its officers to determine whether theyare HIV-positive, because a diagnosis of this condition alone would not result in adirect threat.  ***May employers subject employees to periodic alcohol testing?  (Question 19)***    - Generally, no.  Employers, however, may subject employees who have been in  alcoholrehabilitation programs  to periodic alcohol testing where the employer has areasonable belief that the employee will pose a direct threat in absence of such testing.
  - In determining whether to subject such an employee to periodic alcohol testing, theemployer should consider the safety risks associated with the position the employeeholds, the consequences of the employee's inability or impaired ability to do his or herjob, and the reason(s) why the employer believes that the employee will pose a directthreat.
  - Of course, an employer may maintain and enforce rules prohibiting employees frombeing under the influence of alcohol in the workplace and may conduct alcohol testingfor this purpose if it has a reasonable belief that an employee has been drinking duringwork hours.